My
particular relationship to Alcoholics Anonymous is that
of
a psychiatrist who has seen their miracles at first hand.
We
psychiatrists are used to miracles. There is, for a doctor,
no joy
like that of watching the slow growth into health and confidence
of a miserably unhappy, confused and panic-ridden patient.
As an
analyst, I see every year the deep emotional re-education
we call
psychoanalysis take hold, grow and endure to maturity.

Why
cannot we do this with the acute alcoholic? Why can A.A.
do it? Why is it so often true that the active, heavy drinking
alcoholic - angry, confused, often without money, usually
drunk,
belligerent, hopeless, hiding a deep conviction of worthlessness
behind an offensive arrogance - why is he no candidate for
psychotherapy? He needs help. Why does he resist it?

WHAT
A-A- DOES FOR THE ALCOHOLIC

It
is astonishing to me, now, that we psychiatrists did not
see the "why" right away. It is because he cannot
trust us - he
cannot trust anyone, really. Our first step in any psychotherapy
is establishing what we call a transference. The patient
transfers
to us, for the purpose of a similar emotional education
to that of
early childhood, an abiding faith in us - so that he takes
again
the faltering steps of daring to live, of daring to be himself,
of
daring to make a mistake, or daring to question, of daring
to
learn, of daring to believe that we will not desert him,
and that
we will not let him fall as he starts on his journey of
growing up
all over again.

The
alcoholic, as he begins his climb to sobriety, cannot
possibly do all this. He trusts, implicitly, no one. It
is often
even hard for him to trust and love God, his fear of Him
is so
great. Also, I am reminded of the deep truth of the ancient
question: "If a mam love not his brother, whom he hath
seen, how
can he love God whom he hath not seen?" The alcoholic
cannot
establish a transference - cannot easily love and trust
his
brother, and relate, as a child, to the strange doctor,
labeled
psychiatrist.

But
the alcoholic can, even in his despair, open the door of
his personality just a little crack, tentatively, to another
alcoholic. He does not fear moral condemnation, nor the
equally
obnoxious saintly, stooping, forgiveness, if it comes from
another
drinker who has lived in the same hell as himself. He can
feel a
kinship with another human being, and he has been alone
so long.
Hence we have the beginning of that valuable thing we
psychiatrists (who love to label things) have labelled
"interpersonal relationship." This is, to some,
the essence and
firm foundation of A.A. It establishes and maintains
relationships.

The
next big step toward health is the gradual loss of that
sense of uniqueness most patients have. As you go to A.A.
meetings
and meet more and more people, suddenly the world is full
of
problem drinkers, of alcoholics. Among your friends and
family you
have been a leper, a pariah, an unbelievable catastrophe.
But in
A.A. meetings, you hear your own story over and over. You
begin to
feel free to explore this strange phrase "compulsive
drinker."
Even being called an "addictive personality" by
another in the
same boat does not make you fighting mad. With lots of company,
you dare to take inventory, to explore your own personality,
to
find out your soft Spots, to read the danger signals and
to
recognize and accept a limitation in living that you share
with
all other true alcoholics, that you cannot take the first
drink,
because you are an addict.

ALCOHOLISM
IS AN ADDICTION

A.A.
has done a wonderful job in establishing clearly that
fact - that alcoholism is an addiction. No doctor, no psychiatrist
would tell a heroin or morphine addict that now, since he
has been
off the drug for four or five years, he can take a little
now and
then. But I still see patients in my office, alcoholics,
who have
been told by well meaning psychiatrists that they can become
social drinkers after they solve the conflict underlying
the
drinking problem.

Fortunately,
more and more doctors are learning about
alcoholism. The New York Medical Society on Alcoholism is
both
learning and trying to spread learning in this field and
fewer
patients are chasing the mirage of "social drinking."
We have long
known "once an addict, always an addict" - and
since we now
understand alcoholism as an addiction, it follows inevitably
that
"once an alcoholic, always an alcoholic." Perhaps
some day, in the
dim and distant future of greater knowledge, this may not
be so,
but for us now, with our present light, it is clearly established.

This
fact - that total abstinence is for always - brings in
its wake another need - the need of continued vigilance,
of
renewed reminders. If the far-away causes of alcoholism
in the
personality have not been removed (and we certainly do not
yet
know how to do that), then the danger of those old sleeping
conflicts being stirred up and reactivated will always remain.
This is true - but this is not frightening. A.A. is ever
available
and most A.A.'s sense the need for continued fellowship
in A.A.

THE
SPIRITUAL ELEMENT IN A.A.

Moreover,
something else - something big and wonderful and
unbelievable happens as one goes along in A.A. The fight
gets
easier as the fighter gets stronger. An imperceptible change
is
seen in the alcoholic. No one is trying to convert him to
anything, but he is changing, spiritually. The A.A. program
has no
credal affiliation, but it insists that you call upon your
God, as
you know Him, to help you in your struggle for significance
and
dignity.

In
my opinion, not only as a believer in a living God - but
as a psychiatrist, there is no significance or dignity for
man in
a materialistic, godless world. In my experience as a
psychiatrist, a patient must always come to grips with his
own
deepest personal philosophy of life - its ultimate meaning
and
significance, before he is whole. What that philosophy is,
be he
Jew or Gentile or what-have-you, is none of my business.
But find
it for himself he must. I have had patients of all faiths,
as A.A.
has members members of all faiths. I must not determine
the goal,
but I must help him to find his own goal, however he spells
it.

Learning
how to live seems very unimportant if there is no
meaning in living, nothing to live for but the little immediate
material joys - no bigness, no significance. If man is just
a
little blob of protoplasm, mushrooming up to full size and
then
fading out, wallowing meanwhile in a sea of self-made miseries
and
fighting the elements, it all doesn't seem worth a long
psychotherapy program, or even a striving to sober up. It
must be
remembered that science and psychiatry concerns itself with
method, with "How to," never with objectives to
be reached, never
with "Why." This is the business of the patient
himself - but we
psychiatrists have been too slow in saying that the last
touch of
synthesis after analysis, that last job of spelling it all
out in
terms of meanings - is imperative. I always like to pay
tribute to
one psychiatrist, Smiley Blanton, who dared spell it out
- who did
content himself with just teaching a patient how to love,
maturely
- but gave mature loving its inescapable alternative in
the superb
title of his book Love or Perish (Blanton, 1956).

The
glory of A.A. and, to me, the deepest and strongest
reason for its success, lies in its insistence on the spiritual
growth of the alcoholic. Like the psychiatrist, it does
not chart
creeds - but it suggests, over and over, that you find your
own
chart, your own pathway, to what you call God.

I
heard a distinguished teacher of psychiatry, in a lecture
on alcoholism, say that the addictive personality is a pigmy
at
heart - who uses alcohol over and over, to turn himself
into a
giant, and who needed ever more and more of the stuff in
order to
accomplish that feat. He gave no formula for cure, for the
reversal of trend. I ask, in rebuttal, what turns all of
us
pigmies into giants, automatically? The answer is simple,
the
fatherhood of a living God - living today and loving us.

I
think often of the alcoholic when I remember Paul saying
-
as says the alcoholic in his despairing heart "of myself
I am
nothing" - but then goes on to say with a leap into
the grandiose
"but I can do all things (all mind you) through Christ
who
strengtheneth me." This is to me the secret of A.A.'s
steady
growth - whether you worship the God of Paul, or the God
of Moses
and Abraham, or whether you call him Allah. You achieve
dignity
and significance and you hold on to it and grow quietly
because
you are rooted in a firm, no-longer-debatable conviction
of your
own worth and your own potential.

SUMMARY

In
summary, I would recapitulate. To a psychiatrist who has
had close contact with A.A., and we have had many alcoholics
as
patients, A.A. appears theoretically sound and impressively
successful in achieving and maintaining true sobriety. It
attacks
the drinking problem directly, head on. No therapy of any
kind is
possible while the patient is in an alcoholic fog. It offers
the
alcoholic a desperately-needed opportunity to relate to
other
human beings on a more-or-less equal basis. It continues
to
provide the means of maintaining sobriety, after achieving
it.
Finally, it insists on the importance of spiritual growth
and
spiritual health as the sine qua non of any true health
at all. It
is not a religion, but it values the objectives of religion
- that
is, it sets its sights far higher than just keeping one
sober and
alive and functioning. It aims at helping others through
twelve
step work and thus gives altruism and dignity to all of
its
effort. It lifts the work of A.A. beyond self-preservation
into
nobility.

Truly
I believe "God works in mysterious ways - His wonders
to perform" and truly I believe A.A. is one of His
modern
miracles, worked, as so many miracles were, through his
favorite
medium, mankind.